Evaluation of a national programme to improve shared decision-making skills among junior medical doctors in Denmark: a mixed methods study of satisfaction, usefulness, and dissemination of learning outcomes in clinical practice

Abstract

Background: Shared decision-making (SDM) is a cornerstone in patient-centred care and there has been an increase in programmes aiming to improve clinicians' abilities to engage in it. However, the evidence for such programmes' effectiveness on clinicians' use of SDM in clinical practice is sparse. The SDM Ambassador course, developed and facilitated by the Danish Association of Junior Doctors in Denmark (Junior Doctors Denmark) is a Danish SDM training programme for junior medical doctors (JMDs). This study aims to evaluate the SDM Ambassador course, with a focus on satisfaction, usefulness, and dissemination of learning outcomes in clinical practice.

Methods: This is a mixed methods study, consisting of an online survey followed by semi-structured interviews. The participants were JMDs who had trained to be SDM ambassadors between May 2016 and September 2020 (n=185). The ambassadors were invited to participate in the survey and 112 ambassadors completed it, corresponding to a response rate of 61%. Descriptive statistics and χ²-tests were conducted. Subsequently, purposive sampling was used to identify 10 ambassadors for interviews. The interviews were transcribed, encoded, and subsequently analysed thematically. Finally, the quantitative and qualitative results were integrated.

Results: Overall, the ambassadors were satisfied with their learning outcomes and experienced a greater capacity to unfold the perspectives of their patients. A majority (79%) reported that they had used SDM in their clinical practice with patients, and 59% had disseminated SDM to their colleagues. The usefulness and dissemination of learning outcomes in the clinic were shaped by the ambassadors' perceptions of their moderate professional experience as junior doctors, and constrained by structural and cultural conditions in the context of their clinical practice.

Conclusions: Despite overall satisfaction with their learning outcomes, several ambassadors experienced conditions constraining the translation of their learning outcomes into clinical practice. To improve the efficacy of the training programme, continuous refresher courses should be added, while enhanced support at organisational and political levels is necessary for SDM to become an integral feature of the clinical encounter.

Trial registration: Not applicable.

Keywords: Evaluation; Mixed methods study; Patient-centred care; SDM training programme; Shared decision-making.